Drs. Bratzler and Loeb and Ms. Krusevioski argue that the current Joint Commission's VTE prophylaxis measure is acceptable because it allows for clinicians to document exceptions. However, as we all agree, there are no established prediction rules to identify patients who do not benefit from VTE prophylaxis, and there are no guidelines from national experts on who should be considered low-risk. It therefore seems imprudent to rely on every hospital to develop its own “risk assessment form” to identify patients for whom VTE prophylaxis is not indicated. A better alternative would be to use a more restricted measure that applies only to patients for whom there is general agreement that VTE prophylaxis is indicated. For example, the ACCP recommends VTE prophylaxis for “acutely ill medical patients admitted to hospital with congestive heart failure or severe respiratory disease, or who are confined to bed and have one or more additional risk factors, including active cancer, previous VTE, sepsis, acute neurologic disease, or inflammatory bowel disease”(1). Taking the position that all patients should receive prophylaxis unless an undefined exception is present is not consistent with the evidence found by the American College of Physicians' clinical practice guideline (2), and doing so may have the unintended consequence of encouraging the use of VTE prophylaxis for some low-risk patients for whom the risk–benefit ratio is unfavorable.